State House Notebook: Maine DHHS argument against Medicaid expansion pivots from Alexander study

As the debate over Medicaid expansion rages in the Legislature, the LePage administration is rolling out a coordinated effort among state agencies to focus on the program’s “cannibalizing” of their respective budgets.

The administration also appears to be pivoting from the taxpayer-funded study that it originally hoped would bolster its anti-expansion position.

Additional Photos

Messages between high-level staff at the Department of Health and Human Services, including Commissioner Mary Mayhew, show how the agency is trying to ramp up its argument against expansion of MaineCare. 2014 Press Herald File Photo

Hints of the two-pronged strategy were included in a series of emails inadvertently forwarded to a reporter at the Portland Press Herald. The messages between high-level staff at the Department of Health and Human Services, including Commissioner Mary Mayhew, show how the agency is trying to ramp up its argument against expansion of MaineCare, as Medicaid is called in Maine.

The administration’s anti-expansion case was expected to lean heavily on what’s known as the Alexander Group report, which has already cost the state $185,040 for a Medicaid expansion feasibility study. The report, included in a $925,000 no-bid contract for Gary Alexander, the former welfare chief for Pennsylvania, has been under siege since its release Jan. 10. A national health care analyst said the report contained a $575 million calculation error, omitted savings measures and overstated poverty projections that could balloon the costs of expansion.

While Democrats plan to submit a bill that would nullify the contract, the emails show how officials at DHHS are weighing whether to defend Alexander’s Medicaid study or divert attention from it. On Feb. 11, DHHS spokesman John Martins emailed Mayhew, Sam Adolphsen, the deputy finance director, and Nick Adolphsen, a legislative liaison. He discussed a memo from Erik Randolph, a member of the Alexander Group, that presumably defended the Medicaid study. Sam Adolphsen wrote Friday that he liked the memo, but questioned whether the agency should wait for the “next attack” to make it public.

Martins replied: “We are succeeding on all fronts on getting the expansion message out and the focus on the (Alexander Group) report has died down.”

Martins went on to request “quotable and reliable data” to support the administration’s claim that Medicaid expansion recipients could qualify for subsidies in the federal health care law. He noted that communications directors “across the state have been asked to do (newspaper opinion columns) regarding the impact of Medicaid spending on their programs.”

He concluded: “We haven’t lost anything – we have this (memo) ready for the next salvo – but I think if we have data, especially data that we can report as new, Commissioner, we can accomplish your message objective without tying it to the (Alexander Group) report.”

ALLEGED CONFLICT

Last week, 26 House Republicans signed a letter requesting that House Speaker Mark Eves, D-North Berwick, recuse himself from voting on a bill that would expand Medicaid, the publicly funded health insurance program for the poor.

The Republicans claimed that Eves had a conflict of interest because he works for Sweetser, a behavioral health care organization that receives Medicaid funding.

Eves, whose job at Sweetser is to coordinate care for adults and children with doctors and nurses, said he would not receive a financial benefit from Medicaid expansion.

His alleged conflict has swirled in conservative circles for nearly a year and been flogged with some vigor by the purported news service of the Maine Heritage Policy Center, an advocacy group that opposes expansion and is currently running Facebook ads targeting Republican lawmakers who are considering voting for it. Until last week, the complaints about a conflict have mostly come from MHPC and the governor’s office, which has encouraged reporters to write about it.

That changed when the 26 Republicans went public with their allegations. However, there’s a reason why 32 House Republicans, including leadership, didn’t sign the letter. And it’s the same reason why some staunch opponents of Medicaid expansion believe the allegations are a mistake.

“If we start down that road, there isn’t going to be anybody in this damn place who can vote,” said Rep. Lance Harvell, R-Farmington, who said he refused to sign the letter.

The Maine Legislature is a part-time, citizen legislature. Many of its members have jobs or interests that intersect with public policy that they, as lawmakers, are either voting on or proposing.

Take Rep. Amy Volk, R-Scarborough, who signed the Eves letter. Volk, a business owner, is on the Labor, Commerce, Research and Economic Development Committee, which oversees a variety of labor and regulatory issues that could affect her business, including unemployment compensation changes. According to Volk’s most recent financial disclosure, her husband is a board member of the Maine State Chamber of Commerce, which regularly lobbies her committee and its members on business matters.

In 2007, Rep. Brian Duprey, R-Hampden, who also signed the letter, proposed a bill that would require caseworkers at DHHS to inform welfare-to-work participants of local child care providers and funnel available state subsidies directly to those providers. Duprey owns the day care center Little Blessings. His bill did not pass.

Rep. Tom Winsor, R-Norway, who also signed the Eves letter, may have to decide whether he’ll vote on a MaineCare rides bill that would directly impact Western Maine Transportation Services, which provides MaineCare rides. Winsor is vice president of the company.

Many potential conflicts are either ignored or unknown. The Center for Public Integrity has repeatedly given Maine low grades for its poor disclosure of the financial interests of lawmakers.

Conflict allegations usually accompany divisive issues, which is probably why Eves’ job is the subject of scrutiny.

In 2009, former Democratic Senate President Libby Mitchell was accused of working to exclude bowling alleys from a list of recreational activities that would have been taxed under the now-repealed tax reform law. Mitchell’s son owned a bowling alley in Portland. Former state Republican Rep. Stacy Fitts was frequently criticized by opponents of gridscale wind projects because he worked for an energy company involved in wind projects.

Sometimes a perceived a conflict rises to the level of an Ethics Commission complaint, as it did in 2006 when environmental groups claimed that independent Rep. Thomas Saviello – he’s now a Republican state senator – pressured state officials to drop a violation notice against his employer, International Paper in Jay. The Ethics Commission declined to investigate, while issuing a lengthy opinion about why Saviello could keep his seat on the Legislature’s Environmental and Natural Resources Committee. The commission noted that committee assignments were largely based on a lawmaker’s level of expertise.

For example, there are at least four lawyers on the current Judiciary Committee, five farmers on the Agriculture Committee and five doctors or insurance industry employees on the Insurance and Financial Affairs Committee.

According to the state’s ethics law, “the resolution of ethical problems must indeed rest largely in the individual conscience.”

Eves said last week that it was his conscience that guided his pursuit of Medicaid expansion.

FORTMAN IN PORTLAND

Former Maine Department of Labor chief Laura Fortman will visit Longfellow Books in Portland on Monday to support the Obama administration’s pitch to raise the federal minimum wage to $10.10.

Fortman, now a senior U.S. Department of Labor official, is the principal deputy administrator for the department’s wage and hour division.

In his State of the Union address, President Obama called on Congress to raise the federal minimum wage to $10.10 per hour and index it to inflation thereafter.

Democratic lawmakers in state legislatures have made a similar push. Last year, Gov. Paul LePage vetoed a bill that would increase the state minimum wage to $9 and index future increases to inflation.

Fortman will visit Longfellow Books at 12:30 p.m.

Steve Mistler can be contacted at 791-6345 or at:[email protected]Twitter: @stevemistler

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